Co-creating Virtual Reality Interventions for Alcohol Prevention: Living Lab vs. Co-design

Timo Dietrich, Julie Dalgaard Guldager, Patricia Lyk, Lotte Vallentin-Holbech, Sharyn Rundle-Thiele, Gunver Majgaard, Christiane Stock

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Collaboration with users and stakeholders during intervention design is recommended, but clear documentation of the procedures and considerations for different co-creation methodologies have only recently emerged (1–4) with the need for more work to guide practice and understand relative effectiveness of different co-creation approaches noted. Co-creation ensures that programs are designed with those that are ultimately the recipients of a health intervention. Co-creation is an umbrella term that gained popularity in the early 2000s emerging in areas including (but not limited to) management (5) and software design (6). Co-creation literature focuses on centering service solution development on users, originating from participatory design work dating back to the early 70s (6). Numerous methods have emerged over time and include design thinking (2), co-design (7), co-production (8), and Living Labs (9) highlighting a range of different approaches that can be implemented for intervention co-creation. This paper highlights and contrasts two popular co-creation approaches, namely co-design and the Living Lab.

Co-design is a scientific method of data collection with the aim of including consumers affected by a health intervention (4). Co-designed programs have demonstrated effectiveness across health (10) and environmental issues (1) and thus demonstrated value for researchers, users and society at large (11). More recently, the need to include wider stakeholder groups during the intervention design process has been identified (4) and processes seeking to involve stakeholders within the co-design process to ensure that user solutions identified are feasible have emerged (12). Co-design processes ensure that emphasis is placed on empowering participants and that all solutions emerging from co-design are user centered and stakeholder supported. Recent co-design process models (4, 12) have begun to articulate the necessity to think beyond ideation and gauge how user generated ideas can be translated into effective intervention programs that are endorsed by end-users and stakeholder groups.

The Living Lab methodology is defined as “a design research methodology aimed at co-creating innovation through the involvement of aware users in a real-life setting” [(9), p. 139]. Living Labs have been applied in urban settings (13), entrepreneurial settings (14), professional development (15), and dementia interventions (16), but all take very different structures and forms. Publications on Living Labs began to emerge in the early 2000s and have been predominantly set up and reported within the European context (17). The existing literature has positioned Living Labs as a design method that aims to achieve innovation by setting up environments that allow for end-users to experience and contribute to the solution throughout the developmental stages (9). In other words, it provides a unique setting for collective innovation involving heterogeneous stakeholders such as but not limited to citizens, customers, policy makers, researchers, educators, businesses and universities (18, 19). Living labs remain however significantly underexplored in the academic literature and require further empirical exploration to demonstrate more clearly the scope, benefits and limitations to the approach. Schuurman et al. point out “…[the literature] positions Living Labs too much as an “everything is possible” concept that resembles an empty box, in the sense that you can put whatever methodology or research approach inside” [(17), p. 12].

This paper aims to provide a methodological comparison between two co-creation methods (co-design and Living Lab) to highlight key considerations as well as a comparison of both processes. This study draws its data from two virtual reality case studies, namely a co-design study conducted in Australia and a Living Lab study delivered in Denmark where researchers co-created virtual reality (VR) interventions in an alcohol prevention context. Both virtual reality interventions consist of the simulation of a party situation in which the user can experiment with different communication and behavioral options and both virtual reality interventions are aimed at strengthening alcohol resistance skills. The method section provides the contextual background as well details around how each method was applied to co-create the virtual reality interventions. Next, the paper summarizes the findings and critically discusses and contrasts both co-creation processes.
Original languageEnglish
JournalFrontiers in Public Health
Number of pages6
Publication statusPublished - 15 Mar 2021


  • research methodology
  • promoting health


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